Cerebral angiography during operation for intracranial aneurysms and arteriovenous malformations

Abstract

✓ Angiography during the operative procedure is desirable, but is often difficult because of the problem of maintaining a needle or cannula in an artery for long periods of time. Cannulation of the superficial temporal artery avoids this technical problem. The artery is easily found, cannulation is simple, and obliteration of the artery is of no consequence. Cerebral angiography then provides a means for prompt evaluation of the surgical procedure at any time during the actual operation.

Intraoperative Microvascular Doppler Sonography in Aneurysm Surgery

“…Despite great attempts to preserve patency at the time of the clip application, intraoperative three-dimensional visual inspection of the entire vascular complex may not reveal arterial compromise or occlusion. Total obliteration of the punctured sac of the aneurysm can be tested intraoperatively by angiography [1][2][3][4][5]. In addition, an intraoperative microvascular Doppler sonography system has been used for this purpose in the past few years [6][7][8][9].…”

Utilidad de la angiografía intra-operatoria en el tratamiento quirúrgico de malformaciones arteriovenosas y aneurismas intracraneales

“…Entre las ventajas de la AIO, aporta una adecuada visualización para la resección u obliteración de la lesión vascular, evitando una segunda cirugía y disminuyendo los riesgos asociados con una lesión incompletamente tratada (8) . Además ayuda al planeamiento quirúrgico para realizar una craneotomía dirigida (2,9,10) . La asociación de aneurismas y MAV se encontró en 14,3%, siendo la asociación con aneurismas múltiples 3,4% y con aneurisma único 10,9%.…”

“…Se requirió resección quirúrgica adicional en todos los casos en que se demostró lesión residual, seguido de un segundo control angiográfico, con el objetivo de demostrar la ausencia de la lesión. Los estudios publicados muestran un porcentaje de lesión residual en casos de MAV entre 8% a 27% (9,13) , que son mayores a los encontrados en nuestro estudio. Es importante resaltar que estos valores pueden ser variables en relación a la experiencia y destreza del neurocirujano.…”

Angiographic disappearance and reappearance of an arteriovenous malformation of the cerebellum and brain stem, and its surgical excision a case report

“…Though a postoperative angiogram after the first operation indicated complete excision of the lesion, the patient returned with subarachnoid haemorrhage, and an angiogram indicated reappearance of the lesion. Total excision was carried out at the second operation.Keywords: Arteriovenous malformation; cerebellum; brain stem; cerebellopontine angle; disappearance; reappearance; total excision; postoperative anglogram; intraoperative angiogram.Cerebral angiography is considered the best diagnostic test for diagnosing ~7 arteriovenous malformation (AVM) and intra-or postoperative angiography is strongly recommended for confirming total excision of an AVM 2,13,20 This case is reported because, in addition to the total excision of an AVM of the cerebellum and the brain stem in the cerebellopontine angle, this is probably the first reported case of a disappearing and reappearing arteriovenous malformation on serial cerebral angiograms. …”